Chapter 5
Topics of Special Interest

 

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Adolescent Substance Abuse (Ages 12-17) Polydrug Abuse
Heroin Admissions by Route of Administration
and Planned Use of Methadone
Racial/Ethnic Subgroups

 

This chapter highlights topics that are of current or special interest:

TEDS data indicate a 65 percent overall increase in adolescent admissions for substance abuse treatment between 1992 and 2002, attributable primarily to increased admissions involving marijuana and increased referral to treatment through the criminal justice system.

TEDS data indicate that heroin inhalation and, to a lesser extent, heroin smoking were growing problems among young adults in the 1990s. Despite increases in the numbers of admissions for heroin abuse, the number where methadone use was planned as a part of treatment declined.

Polydrug abuse (the use of more than one substance) was more common among TEDS admissions than was the abuse of a single substance.

TEDS permits analysis of racial/ethnic subgroups that are generally poorly represented in sample surveys. Substance abuse patterns differed widely among racial/ethnic subgroups; however, alcohol was the predominant substance for all racial/ethnic groups, except persons of Puerto Rican origin.

Adolescent Substance Abuse (Ages 12-17)

TEDS data indicate an overall increase in adolescent admissions aged 12 to 17 for substance abuse treatment between 1992 and 2002, attributable primarily to increased admissions involving marijuana and increased referral to treatment through the criminal justice system.

Tables 5.1a and 5.1b and Figure 28. The number of adolescents aged 12 to 17 admitted to substance abuse treatment increased 65 percent between 1992 and 2002. This increase is largely accounted for by the increase in the number of adolescent primary marijuana admissions (350 percent between 1992 and 2002). The proportion of adolescent primary marijuana admissions grew from 23 percent of adolescent admissions in 1992 to 63 percent in 2002.

The number of adolescent primary stimulant and primary opiate admissions also increased (by 345 percent and 166 percent, respectively) from 1992 to 2002, but the proportion of adolescent admissions for stimulants represented only 4 percent of all adolescent admissions in 2002, while the proportion of adolescent primary opiate admissions was 1 percent.

Adolescent treatment admissions for primary alcohol and primary cocaine abuse decreased over this time period. The proportion of adolescent primary alcohol admissions decreased from 56 percent in 1992 to 20 percent in 2002, as the number of adolescent alcohol admissions fell 40 percent. Cocaine accounted for 2 percent of adolescent admissions in 2002, down from 4 percent in 1992; the number of adolescent primary cocaine admissions decreased by 24 percent over this time period.

Table 5.2a. Overall, 70 percent of adolescent admissions were male. However, this proportion was heavily influenced by marijuana admissions, where 76 percent were male. The proportions of adolescent female admissions were greater than those for adolescent males for methamphetamine/amphetamines (58 percent female vs 42 percent male) and for heroin (52 percent female vs 48 percent male). The proportions of adolescent male and female admissions were similar for non-smoked cocaine (50 percent each).

Table 5.2a. In 2002, more than half (53 percent) of adolescent admissions were referred to treatment through the criminal justice system. Seventeen percent were self- or individual referrals, and 11 percent were referred through schools.


Figure 28
Adolescent admissions by primary substance: TEDS 1992-2002
 


SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) - 3.01.04.


Figure 29.
The number of admissions referred by the criminal justice system increased every year but one from 1992 to 2002. Admissions resulting from self- or individual referrals, schools, and other referral sources have been stable or declined slightly since 1995.

Table 5.3. In 2002, 48 percent of all adolescent admissions involved the use of both alcohol and marijuana. Admissions involving both alcohol and marijuana increased by 86 percent between 1992 and 2002. Admissions involving primary marijuana and no alcohol increased by 632 percent. Over the same period, admissions involving primary alcohol and no marijuana declined by 60 percent.


Figure 29
Adolescent admissions by referral source: TEDS 1992-2002
 


SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) - 3.01.04.


Tables 5.4a and Figure 30.
An admission was considered marijuana-involved if marijuana was reported as a primary, secondary, or tertiary substance. Between 1992 and 2002, the number of marijuana-involved adolescent admissions increased for both criminal justice and other referral sources. However, the number of marijuana-involved adolescent admissions originating in the criminal justice system increased every year from 1992 to 2002, while the number of marijuana-involved adolescent admissions from other referral sources increased only through 1996, then stabilized. Beginning in 1998, marijuana-involved adolescent admissions referred through the criminal justice system outnumbered those entering treatment through other referral sources. Adolescent admissions not involving marijuana declined between 1992 and 2002, regardless of referral source.


Figure 30
Adolescent admissions by marijuana involvement and criminal justice referral: TEDS 1992-2002
 


SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) - 3.01.04.


Heroin Admissions by Route of Administration and Planned Use of Methadone

TEDS data indicate that heroin inhalation and, to a lesser extent, heroin smoking were growing problems among young adults in the 1990s. Despite increases in the numbers of admissions for heroin abuse, the number where methadone use was planned as a part of treatment declined.

Tables 5.5a and 5.5b. Heroin admissions increased by 68 percent between 1992 and 2002. Increases of 171 percent in admissions for heroin inhalation and 31 percent in admissions for heroin injection were largely responsible. The proportion of heroin admissions represented by injection declined from 77 percent in 1992 to 62 percent in 2002. Heroin inhalation made up 33 percent of all heroin admissions in 2002, an increase from 20 percent in 1992.

Tables 5.5a and 5.5b and Figure 31. The planned use of methadone as part of treatment did not keep pace with the increase in heroin admissions. While heroin admissions increased by 68 percent between 1992 and 2002, the planned use of methadone increased by 2 percent. In 2002, methadone use was more likely to be planned for heroin injectors and smokers (38 percent each) than inhalers (32 percent). Among admissions for heroin injection, planned use of methadone fell by 18 percent between 1992 and 2002. The proportion of admissions for heroin inhalation that included planned use of methadone rose from a low of 23 percent in 1996 and 1997 to about 30 percent between 1998 and 2002, a level below the 44 percent reported in 1992.


Figure 31
Planned use of methadone by route of heroin administration:
TEDS 1992-2002
 


SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) - 3.01.04.


 

Table 5.6b and Figure 32. Between 1992 and 1999, the proportion of admissions under age 30 decreased among heroin inhalers and increased among heroin injectors. Until the year 2000, heroin inhalers admitted to treatment tended to be younger than heroin injectors admitted to treatment. In 1992, 45 percent of admissions for inhalation were under 30 years of age, compared to 21 percent of those injecting heroin. By 2002, the proportion of those admitted for inhaling heroin who were under age 30 had fallen to 22 percent. The proportion admitted for injecting heroin who were under age 30 had increased to 31 percent. Among heroin smokers, the proportion under age 30 was 37 percent.

Table 5.6a. Among heroin abusers experiencing a first treatment episode in 2002, the average duration of use was 12 years for both injection and inhalation, and 11 years for smoking.


Figure 32
Heroin admissions under age 30 by route of administration:
TEDS 1992-2002
 


SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) - 3.01.04.


Polydrug Abuse

Polydrug abuse (the use of more than one substance) was more common among TEDS admissions than was the abuse of a single substance.

Table 5.7 and Figure 33. Polydrug abuse was reported by 55 percent of all TEDS admissions in 2002. Alcohol, marijuana, and cocaine were the most commonly reported secondary and tertiary substances.

Abuse of alcohol as a primary, secondary, or tertiary substance was characteristic of most treatment admissions. Nearly half (43 percent) of all treatment admissions were for primary alcohol abuse, and 22 percent of admissions for other drugs reported that they also had an alcohol problem. Overall, 65 percent of all treatment admissions reported alcohol as a substance of abuse.

Alcohol and opiates were reported more often as primary substances than as secondary or tertiary substances. Twenty-three percent of all admissions involved opiate abuse, with 18 percent reporting primary abuse and 5 percent reporting secondary or tertiary abuse.

For marijuana and cocaine, more admissions reported these drugs as secondary or tertiary substances than as primary substances. Marijuana was reported as a primary substance by 15 percent of all admissions, but was a secondary or tertiary substance for another 20 percent, so that 35 percent of all treatment admissions reported marijuana as a substance of abuse. Cocaine was a primary substance for 13 percent of admissions, but was a secondary or tertiary substance for an additional 17 percent. Thus nearly one-third (30 percent) of all treatment admissions involved cocaine abuse.


Figure 33
Primary and secondary/tertiary substance abuse: TEDS 2002
 


SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) - 3.01.04.


Table 5.8. This table details the most common substance combinations for selected primary substances. For example, for primary alcohol admissions, 55 percent reported abuse of alcohol alone, 15 percent reported abuse of alcohol and marijuana but no other drugs, and 7 percent reported primary abuse of alcohol with abuse of cocaine and marijuana as secondary and tertiary substances.

Racial/Ethnic Subgroups

TEDS permits analysis of racial/ethnic subgroups that are generally poorly represented in sample surveys.

Tables 3.1a, 3.1b, 3.2a, and 3.2b and Figures 34-39. Substance abuse patterns differed widely among racial/ethnic subgroups in 2002. However, alcohol was the predominant substance for all racial/ethnic groups except persons of Puerto Rican origin. The proportion of admissions with alcohol as the primary substance ranged from 28 percent for persons of Puerto Rican origin to 63 percent for American Indians and Alaska Natives [Table 3.1b].

Among non-Hispanic Whites [Figure 34 and Table 3.2b], alcohol as the primary substance accounted for 52 percent of admissions among males and 40 percent of female admissions. Marijuana and opiates were the most frequently reported illicit drugs for non-Hispanic White men (15 percent each), followed by cocaine and stimulants (7 percent each). For non-Hispanic White women, opiates were the primary illicit drug (19 percent), followed by stimulants (12 percent), and cocaine (11 percent).

Among non-Hispanic Blacks [Figure 35 and Table 3.2b], 37 percent of male admissions and 27 percent of female admissions involved alcohol as the primary substance. Cocaine was the most commonly reported illicit substance for both men and women (24 percent and 35 percent, respectively). This was followed by marijuana (20 percent) and opiates (15 percent) for men and opiates (19 percent) and marijuana (13 percent) for women.

Among Hispanics, substance abuse patterns differed according to country of origin. Among persons of Mexican origin [Figure 36 and Table 3.2b], alcohol was the primary substance involved in 45 percent of male admissions, but only 26 percent of female admissions. Opiates were the most commonly reported illicit substances for both men and women (19 percent and 21 percent, respectively). For men, this was followed by marijuana (16 percent), stimulants (11 percent), and cocaine (7 percent). For women, it was followed by stimulants (26 percent), marijuana (14 percent), and cocaine (11 percent).

Among persons of Puerto Rican origin [Figure 37 and Table 3.2b], opiates were the main substances at treatment admission for both men and women (50 percent and 46 percent, respectively). Opiates were followed by alcohol (29 percent), marijuana (11 percent), and cocaine (8 percent) for men. For women, alcohol (25 percent), cocaine (14 percent), and marijuana (11 percent) were the next most common primary substances. Admissions for stimulant use were rare.

American Indians and Alaska Natives together accounted for 2 percent of all TEDS admissions [Table 3.1a]. Among American Indian/Alaska Native admissions, 68 percent of men and 54 percent of women entered treatment because of primary alcohol abuse [Figure 38 and Table 3.2b]. Marijuana was the most frequently reported illicit substance, responsible for 14 percent of male and 12 percent of female admissions. This was followed by opiates (7 percent), stimulants (5 percent), and cocaine (4 percent) for men. For women, stimulants and opiates accounted for 13 percent and 10 percent of admissions, respectively, while cocaine accounted for 7 percent.

Asians and Pacific Islanders accounted for approximately 1 percent of all TEDS admissions [Table 3.1a]. Among this group [Figure 39 and Table 3.2b], 36 percent of male admissions and 25 percent of female admissions involved alcohol as the primary substance. Stimulants and marijuana were the most commonly reported illicit drugs for men (22 percent and 21 percent, respectively). Among women, however, 33 percent of admissions were for stimulants and 18 percent for marijuana. For both men and women, opiates accounted for 10 percent of admissions, while cocaine was responsible for 10 percent of female admissions and 9 percent of male admissions.


Figure 34
White (non-Hispanic)
Admissions by primary substance, sex, and age: TEDS 2002
 


SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) - 3.01.04.


 
Figure 35
Black (non-Hispanic)
Admissions by primary substance, sex, and age: TEDS 2002
 


SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) - 3.01.04.



Figure 36
Mexican origin
Admissions by primary substance, sex, and age: TEDS 2002
 


SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) - 3.01.04.


 
Figure 37
Puerto Rican origin
Admissions by primary substance, sex, and age: TEDS 2002
 


SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) - 3.01.04.


 
Figure 38
American Indian/Alaska Native
Admissions by primary substance, sex, and age: TEDS 2002
 


SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) - 3.01.04.


 
Figure 39
Asian/Pacific Islander
Admissions by primary substance, sex, and age: TEDS 2002
 


SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) - 3.01.04.